Lessons from teen's death live on

Deb McMillan remembers stepping to the podium at a medical conference in Boston.

Her hands trembled as she looked into the audience of 100 doctors and nurses. But thoughts of her son and the need to tell his story calmed her.

Tyler Kahle, a 19-year-old Omahan with a chiseled face and a big smile, died seven years ago from aortic dissection, an uncommon but often deadly condition that can be difficult to diagnose.

First-ever national guidelines for diagnosing and treating the condition, a tear in the lining of the body's largest artery, the aorta, were released Tuesday by the American Heart Association and other groups. The guidelines will be made available to emergency room doctors and other providers.

The Omaha teen's death influenced two key points in the guidelines, said Dr. Dianna Milewicz, a Texas researcher who helped write the document and is familiar with Tyler's case.

The condition can affect persons of any age, including teens, and family history is a significant risk factor.

“Tyler's (death) was an incredible tragedy,'' Milewicz said. “What happened to him could have been prevented.”

Tyler's death resulted in a lawsuit against Methodist Hospital and an out-of-court settlement that included creation of a video produced by the hospital and released in 2007.

McMillan has spoken to medical groups in other parts of the country and written more than 100 letters and e-mails to doctors and others describing her son's case.

She always emphasizes the need for a uniform national checklist for physicians.

Aortic dissection can be spotted with medical imaging equipment and can be treated, but that never happened with her son.

During an eight-day span in fall 2002, Tyler went twice with chest pains to the Methodist Hospital emergency room and once to his family doctor at Methodist Physicians Clinic.

All three times, Methodist physicians diagnosed and treated him for upper respiratory problems.

His mother repeatedly told Methodist doctors about her son's family history of aortic dissection (an uncle died of it, and his father and a brother survived aortic dissections), but he was never given a scan for the ailment. He died four days after his last trip to the emergency room.

Misdiagnosis can be a problem with aortic dissection, said Dr. Loren Hiratzka, an Ohio surgeon and chairman of the committee that wrote the guidelines.

Symptoms can sometimes be vague, like a mild ache in the chest or back, Hiratzka said. Other times a person might collapse but have no other symptoms.

There's also a lack of awareness about the condition, partly because doctors don't see a lot of cases, he said. There are an estimated 10,000 deaths annually in the United States from the condition, although doctors believe the count is likely higher.

The guidelines say CT and MRI scans are the best ways to detect the condition and that a chest X-ray alone is not sufficient.

The guidelines also emphasize the importance of asking patients about any family history of the condition or of unexplained sudden death.

Methodist doctors acknowledge in the video the mistakes that the hospital made in diagnosing the medical problem that caused Tyler's death.

Methodist has distributed the video nationally to doctors and hospitals. The hospital also posted the video on its Web site, where it has been viewed more than 12,000 times in the United States and such countries as China, Germany and India.

Parts of the video are a tribute to the young man. It shows him graduating from high school, skateboarding, waveboarding and doing the other kinds of high-energy activities he loved.

McMillan still cries when she watches the video and thinks about Tyler every day.

Her brightest moments are when she receives a letter from someone who got tested for the condition after watching the video or hearing about Tyler's case.

“He was sweet and was always doing things for other people,” she said. “I guess he's still (doing) that.”

Contact the writer:

444-1122, michael.oconnor@owh.com

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